Analysis: Obamacare a pickle for McConnell, Grimes

WASHINGTON – The early success of Kentucky's health care exchange, kynect, is creating quandaries for both Mitch McConnell and Alison Lundergan Grimes as they address Obamacare in the Kentucky Senate race.

For McConnell, the Senate minority leader, continued attacks on Obamacare — the Affordable Care Act — pose risk because the law's implementation under kynect has produced 421,000 enrollees in the Bluegrass State, and more public support than opposition.

For Grimes, the issue is whether to fully embrace the exchange's success as she tries to rally key elements of the Democratic base that is largely for the health care law — while still separating herself from President Barack Obama, who is unpopular in the state.

"They both have to be careful," said Jennifer Duffy, senior editor for the nonpartisan Cook Political Report, who noted that consensus is emerging that Obamacare can't be repealed without widespread chaos. And if that is the case, then McConnell and other Republicans must be more specific about what would replace the law and what would happen to the state exchanges.

Grimes, on the other hand, has two choices, Duffy said: "She either acknowledges that kynect is a success and she sort of becomes a booster for it, but in that takes on the risk of being tied to the president. Or, she acknowledges voters see (kynect and Obamacare) as different and plays the same game McConnell is playing."

Neither McConnell nor Grimes was made available for interviews for this story.

Susan Zepeda, president of the Foundation for a Healthy Kentucky, a Louisville-based nonprofit that since 2001 has invested $24 million in health research and other programs, said the health care debate is more complicated than "repeal Obamacare" or "support kynect."

"Campaign politics does not lend itself to a deep-dive into the complexities of multifaceted issues of what access to health care and payment for health care means to Kentucky communities and to Kentuckians," she said.

Hurdles for McConnell

Although kynect appears to have been successful so far, more hurdles are ahead as federal subsidies for Medicaid drop, insurers set new rates and employers find out what they may have to pay to cover their workers.

Even so, the national Republican drumbeat against the Affordable Care Act has become a bit more muffled after a bumpy roll-out that nevertheless enrolled 8 million Americans.

McConnell's problem with the issue was illustrated during a May 23 news conference in Louisville. After blistering Obamacare as "the single worst piece of legislation to pass in the last 50 years," the senator was asked whether state exchanges like kynect should be dismantled.

McConnell reverted to arguments he has made in favor of legislation that would permit health insurance to be sold across state lines and limit lawsuits against physicians.

When pressed on what should happen to kynect, McConnell said: "I think that's unconnected to my comments about the overall question."

His campaign later sent out a statement saying Kentucky should decide whether to keep kynect or some other system if Obamacare is repealed.

"But Kentuckians shouldn't have been forced to lose the plans they had and liked, shouldn't have seen their premiums skyrocket, shouldn't have had their Medicare cut, and shouldn't have had their taxes raised because ... President Obama and his friends in Washington forced it down their throats," campaign spokeswoman Allison Moore said.

Critics immediately pounced on McConnell's comments as a cynical ploy to try to confuse Kentucky voters.

Gov. Steve Beshear, who is the exchange's champion and largely credited with its success, pointed out in a Huffington Post opinion column that nearly 1 in 10 Kentuckians has enrolled in kynect.

"At best, of course, (McConnell's) promise represents a fundamental misunderstanding of the ironclad link between the ACA and 'kynect.' At worst, it's a blatant attempt to mislead Kentucky families for his political benefit," the governor charged.

"The salient point," the governor added, "is this: Even critics are acknowledging that the ACA is bringing health care to those who desperately need it. In short, it's working."

University of Kentucky political scientist Stephen Voss said that for Democrats, "kynect works better as branding here than Obamacare."

So for McConnell, kynect "is not as promising a battleground ... as the Obamacare side of the debate."

McConnell maintained in a Senate speech Thursday that Obamacare was bad for Kentucky, but he never referred to the state exchange by name.

"Obamacare has already inflicted tremendous pain on the lives of countless middle class Americans, including many thousands in my own state," he said in opposing Sylvia Burwell's confirmation as secretary of health and human services.

Former Vermont Gov. Howard Dean, a physician and former chairman of the Democratic National Committee, said the issue presents peril for McConnell.

"Here you've got a not very popular Republican, McConnell, ... who's led the national effort to kill Obamacare, and he's now going home to the state whose people have benefited the most from Obamacare," Dean said on MSNBC on Wednesday. "He's got a big problem."

U.S. Rep. John Yarmuth, a Louisville Democrat and adviser to Grimes, said, "McConnell understands he's in a real box. He can't repeal (Obamacare) root and branch and not undo all the good stuff in Kentucky."

Views based on name

Still, Republicans insist the health care issue favors them.

"I have not seen concern about Obamacare wane in the Commonwealth of Kentucky," said Steve Robertson, chairman of the Kentucky Republican Party.

He has said GOP state legislative candidates are going to run against the health care law and intend to push for a rollback in the expansion of Medicaid if the party takes over the state House this November or wins the governorship next year.

"My views have not changed," Robertson said. "There is so much upheaval in the health care market."

Yarmuth speculated that McConnell and the GOP are "trying to play both sides of the polls" that show Kentuckians' support of the health care law varies, depending on what it is called.

A Bluegrass Poll conducted in May for The Courier-Journal, Lexington Herald-Leader, WHAS-TV and WKYT-TV found 56 percent of registered Kentucky voters felt the Affordable Care Act had gone too far in changing the health care system, 20 percent said it did not go far enough and 17 percent thought it was about right. Among Democrats, 59 percent felt either the law was about right or did not go far enough; 81 percent of Republicans felt it went too far.

Meanwhile, an NBC News-Marist Poll conducted in May found that when asked about Obamacare, 57 percent of Kentucky registered voters said they had an unfavorable view of it and 33 percent had a favorable view.

But when asked about kynect, 29 percent had a favorable view, while 22 percent had an unfavorable view. Twenty-one percent were unsure about their views on kynect, while 27 percent said they hadn't heard of it.

Kentuckians were even more supportive of expanding Medicaid to provide health coverage for low-income people in the Kentucky Health Issues Poll conducted in October and November 2013 for the Foundation for a Healthy Kentucky and Interact for Health.

In that survey, 79 percent of Kentucky adults said they favored Medicaid expansion for health care.

Grimes frustrates advocates

Grimes so far has expressed a muddled view on the health care law. In Beattyville, Ky., on May 21, she twice was asked whether, if she had been a senator, she would have voted for the law, which became law in 2010. She did not answer.

"I, when we are in the United States Senate, will work to fix the Affordable Care Act," The Associated Press quoted her as saying. "I believe the politically motivated response you continue to see from Mitch McConnell in terms of repeal, root and branch, is not in reality or keeping ... with what the facts are here in Kentucky."

Grimes signaled her support for kynect, but it was hardly a ringing endorsement: "I am not and will not be for taking away insurance that 400,000 Kentuckians just recently got access to."

A week earlier, Grimes issued a statement commending Beshear's "hard work to expand health insurance access to hundreds of thousands of Kentuckians."

"However, the Affordable Care Act is not perfect; there are parts that need to be fixed," she said. "We must investigate and address the botched national roll-out, offer relief to small businesses, make sure individuals can keep their current plans, and address affordability issues."

Asked whether he believed Grimes intended to be more specific about her views on Obamacare, Yarmuth offered: "At some point she will."

But advocates for the state law are frustrated with Grimes' handling of health care policy.

"I wish she would come out and actually take a stand on it," said Regan Hunt, executive director of Kentucky Voices for Health, a coalition of 250 health organizations. "All we get out of her right now is, there are a lots of things about health reform that she would like to change."

Hunt said that for McConnell to suggest that Kentucky could somehow preserve its exchange after a repeal of the Affordable Care Act "shows how disconnected he is."

"A lot of the money for (kynect's) infrastructure, support staff, and call center is funneled through federal grants from the Affordable Care Act," Hunt said. "Kentucky does not have enough money to sustain this on its own. ... It would be like taking away Medicaid or taking away Medicare."

Grimes could make that argument, said Joseph White, the director of Case Western Reserve University's Center for Policy Studies and a specialist in health care politics and policy.

With Kentucky's enrollment far above the national norm, "people are more likely to know someone who has been helped," he said.

"Then it's really a challenge for (Grimes) to make the point — to run ads saying, 'Why does Senator McConnell want to defund kynect?' " he said. "The effect in Kentucky will depend a lot on whether Grimes chooses to and succeeds in making that point."

Ultimately the nuances of McConnell's and Grimes' positions on health care may be lost on voters, Voss said.

"At the end of day, people are going to know he's got problems with it … and she's supportive, with some quibbles," he said.

Reporter James R. Carroll can be reached at (703) 854-8945. Follow him on Twitter @JRCarrollCJ.